Yoga for Multiple Sclerosis,
Part II

Part I of Karen's article, published in the Fall Yoga Bulletin, discusses the disease process of MS, its accompanying symptoms, and how yoga can help. To access the article online, go to the Archive search engine and choose Karen's name in the author category. Below, Karen offers practical information on teaching a yoga class for students with MS.

Teaching considerations

The yoga space should be

• Handicapped accessible with easy access to parking, hallways, and entry
• Free of obstacles
• Adjacent to a handicapped-accessible bathroom
• 70 degrees; a too-hot or too-cold room may exacerbate symptoms. Humidity also affects symptoms.

Maintain safety with

• Props (chairs, tables, blankets, bolsters, ties, blocks) to maintain proper alignment, reduce fatigue, and aid balance and relaxation
• Gentle, repetitive movements
• Short holding times
• Slow movements and transitions
• Informed consent for hands-on assistance
• "Less is best" developmental approach to postures. Encourage students to conserve their energy.
• Small class size, depending on the number and severity of disability
• Placement of chairs on sticky mats to keep them from sliding.

Socialization: Be aware that students who come to class may be disabled and even isolated at home alone most of the time. They may feel self-conscious about their inability to move their bodies the way that they want to or used to. They may want to talk in class about what's going on for them.

Learning styles: Guided imagery can be freeing for students with serious physical limitations. Consider describing details through the imagery of feeling, hearing, and seeing.

Restorative yoga: Passive stretching and deep relaxation can actually improve mobility and cognitive function by inducing the relaxation response in the body. Guided meditation and focus on breath within restorative postures allows the student a deeper experience without the stress of moving a resistant body. Restorative poses are especially helpful for students with limited mobility. Consider starting the class or session with restorative postures and end with seated postures and meditation.

Teacher's liability insurance: Some insurance policies allow teachers to purchase "additional insured" riders for the locations in which they teach.

Boundaries and confidentiality: These issues may arise due to familiarity between students and teacher. Some students are very private about their health and others need to be able to talk about their situations.

Symptom awareness

Balance: Place a folding chair on a sticky mat, close to a wall if possible. Supported balancing postures increase muscle strength, improve posture, and increase self-confidence.

Bladder control problems: Make sure a handicapped-accessible bathroom is within easy walking or wheeling distance for the student. Bladder incontinence can be caused by myelin damage to the nerves responsible for urinary control. Some students may have the opposite problem and are unable to relax the sphincter muscles. The practice of mula bandha may be helpful in these cases.

Cognitive concerns: Repeat instructions. Some students will have short-term memory loss and may appear confused or disoriented at times. Consider having a family member present for private sessions.

Fatigue (including effects of interferon drugs): Offer classes in the mid-morning or early evening. Vary the postures to avoid fatiguing the muscles. Poses should not be held longer than a count of ten, with frequent breathing breaks and restorative poses sprinkled throughout the class. Limit classes and private sessions to between 45 and 60 minutes.

Muscle spasticity: Classes that begin with relaxation and guided imagery can reduce spasticity to allow gentle stretching. Avoid full contractions and holding. Even stretching must be done carefully because the opposing muscles contract. Focus on gentle joint rotations and then gentle stretching. Dirgha and ujjayi breathing will assist in relaxation, as will relaxing music.

Muscle weakness: Build postures developmentally, offering the least stretch to the most in a given posture. That way the student decides how much is enough. For example, students can stand or sit in Mountain pose with the arms alongside the chair or hands on the waist or with arms straight up next to the ears and fingers pointed toward the ceiling. Each student decides which version works for him or her that day.

Focus on chair yoga for students who have difficulty standing. Avoid floor postures, including relaxation, unless the student can easily get down and up without assistance. Don't risk helping students with muscle weakness to get onto the floor; it may take all their energy to get back up and increase the risk of injury. For relaxation, students can sit in their chairs or wheelchairs, resting the head on arms or folded blankets, or stand and rest on a tabletop.

Sensory sensitivity: Numbness in particular can create pain and balance issues. For example, gluteal and leg numbness can cause discomfort and pain in postures that require sitting or kneeling. Even lying down on a firm surface for relaxation can cause pain or discomfort. The student may also feel out of balance because one side of the body may be numb and not the other.

Drugs: Some students may have intramuscular ports for IV drug interventions; others may self-administer shots. Approximately half of those with MS take some sort of disease-modifying drugs which are administered at various intervals: daily, weekly, or monthly. Some drugs can cause flu-like symptoms and fatigue in the hours and days following administration. Teachers who work with MS students should find out what drugs their students are taking and what the side effects are for each person.

The philosophy of yoga offers a way of living peacefully with what is and knowing that disease does not define a person. Liberation through yoga is as close as the breath. In the words of Thich Nhat Hanh, "Breathing in, I am aware that I am breathing in. Breathing out, I am aware that I am breathing out." In that moment-to-moment awareness, all other concerns drop away.

Teachers, the best thing that you can offer your students is your loving and compassionate presence. You are a witness to your student's experience. Your love and acceptance is yoga.

Karen Clarke is a certified professional-level Kripalu yoga teacher, Integrative Yoga Therapist, and Yoga of the Heart TM instructor. In addition to leading workshops and teaching full-time in southeastern Connecticut, she teaches and consults for the Greater Connecticut Chapter of the National Multiple Sclerosis Society. Karen's CD, Yoga Heals Us: Gentle Yoga for Every Body, is available at www.yogahealsus.com.